What is the role of induction in the diagnosis of psychogenic nonepileptic seizures (PNES)?

Updated: Jul 26, 2018
  • Author: Selim R Benbadis, MD; Chief Editor: Helmi L Lutsep, MD  more...
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Provocative techniques, activation procedures, or inductions, can be extremely useful for the diagnosis of PNES, particularly when the diagnosis is uncertain and no spontaneous episodes occur during monitoring.

Many epilepsy centers use a provocative technique to aid in the diagnosis of PNES. An intravenous injection of saline is traditionally and most commonly used, but other techniques may be preferable.

The principle behind provocative techniques is suggestibility, which is a feature of somatoform disorders in general. For example, in psychogenic movement disorders, for which the diagnosis rests solely on phenomenology (sometimes aided by EMG), the response to placebo or suggestion is considered a diagnostic criterion for a definite psychogenic mechanism.

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